Objective To carry out a comprehensive and objective evaluation of viscosupplementation, so as to provide the actual judgments of effectiveness, development trends, and direction. Methods The related l iterature was reviewed, and the keys were the assessments from the international relevant advisory bodies and insurance companies and the evidence-based medicine on cl inic. Results Viscosupplementation has been gradually accepted. Although there are many different cl inical views of the viscosupplementation in the molecular weight of hyaluronan, injection dose, and the indications, intra-articular injection of hyaluronan for the treatment of osteoarthritis is well accepted. ConclusionViscosupplementation is one of the methods of treating osteoarthritis. As it has been already verified that hyaluronan iseffective in treating osteoarthritis of the knee and the periarthritis of shoulder, the hip joint injection is gradually recognized,and other small joints are going gradually.
Objective To analyze and compare the domestic quality standard and foreign quality standard of sodium hyaluronate (HA), and to expatiate on the critical process monitoring parameters. Methods Different quality standards of HA were compared by translating and sorting, and some experimental data were analyzed as well as the manufacturing practice was elaborated. Results Differences exist in raw materials standard or specifications of products between domestic and foreign, but the basic control points are concordant. Conclusion The company should set up reasonable and controllable quality standard based on quality requirements and related process characteristics so as to assure the safety and effectiveness of the clinical application.
目的:评价双醋瑞因联合玻璃酸钠治疗骨关节炎的临床疗效。方法:采用回顾性临床对照研究方案设计,65例膝骨关节炎患者应用关节腔内注射玻璃酸钠治疗为对照组,69例膝骨关节炎患者在玻璃酸钠基础治疗的同时合用双醋瑞因6个月作为联合治疗组,通过VAS评分、WOMAC评分、ESR和CRP在治疗前、治疗后1个月、3个月和后3个月3个时段四个时间断面的病情改变作为疗效判断指标。结果:与治疗前相比,两组的关节触痛、20米步行痛评分、WOMAC评分、ESR和CRP有明显改善(Plt;0.001);在治疗后的3个月,各个观察指标联合治疗组明显优于对照组(χ2=5.256,Plt;0.05);在治疗后的第2、3个月和治疗后的后3个月两个时段,应用NSAIDs的患者例数上,联合治疗组明显少于对照组(P=0.022;χ2=10.428,P=0.001),在治疗初的1个月内两组无差异(χ2=0.137,P=0.711),并且未发生严重不良事件。结论:双醋瑞因和玻璃酸钠二者对骨关节炎治疗都有临床疗效;在对OA采用玻璃酸钠治疗的基础上,同时合用和维持治疗,临床疗效更持久有效,值得临床推广。
ObjectiveTo observe the clinical effect of combined traditional Chinese and Western medicine in the treatment of knee osteoarthritis (KOA). MethodsA total of 180 KOA patients treated between January 2012 and June 2015 were randomly assigned to 3 groups: Chinese medicine group (group A, n=60) with acupuncture and irradiation therapy of specific electromagnetic wave therapeutic apparatus , western medicine group (group B, n=60) with oral glucosamine hydrochloride tablets and knee joint cavity injection of sodium hyaluronate, and integrated traditional Chinese and Western medicine group (group C, n=60) with treatments combining those in both group A and B. The treatment course was 6 weeks. The Western Ontario & McMaster University (WOMAC) osteoarthritis index score and total effective rate were evaluated before treatment and 2 weeks after treatment, end of treatment and 5 months after treatment. ResultsAfter treatment, the average improvement of WOMAC scores in the three groups was significantly different (P ＜ 0.05) . The total effective rate was 78.33% in group A, 83.33% in group B, and 91.67% in group C. The difference of total effective rate between group C and A, and between group C and B was statistically significant (P＜0.05) ; and it was also statistically significant between group A and B (P ＜ 0.05) . There were two cases of adverse reactions in group A, two in group B, and two in group C, and the reactions were all relatively mild without any serious adverse events. ConclusionsChinese medicine and western medicine are both effective and safe for the treatment of KOA. When they are combined, the effect is further enhanced with no increase of adverse reactions.
ObjectiveTo investigate the safety and efficacy of human umbilical cord mesenchymal stem cells (MSCs) by intra-articular injection for degenerative knee osteoarthritis. MethodsBetween January 2015 and January 2016, 36 patients with moderate or severe degenerative knee osteoarthritis were randomly devided into 2 groups (n=18). Intra-articular injection of 2.5-3.0 mL human umbilical cord MSCs suspension containing (2-3)×107 cells was performed once a month for 2 times as a course of treatment in the cell treatment group; sodium hyaluronate by intra-articular injection was used once a week for 5 times as a course of treatment in the control group. There was no significant difference in gender, age, body mass index, side, stage of osteoarthritis, course of disease, and preoperative Lysholm score of the knee joint, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and SF-36 scale score between 2 groups (P > 0.05). The clinical efficacy was evaluated by SF-36 scale score, Lysholm score, and WOMAC score. ResultsAll patients of 2 groups received a course of treatment. The patients were followed up for 6 months. After injection, the incidences of pain and swelling in the cell treatment group were significantly higher than those in the control group (χ2=16.200, P=0.000; χ2=11.688, P=0.000), but no significant difference was found in the incidence of effusion (χ2=2.118, P=0.146). In the cell treatment group, Lysholm score at 1-6 months after treatment, WOMAC score and SF-36 scale score at 2-6 months after treatment were significantly better when compared with scores before treatment (P < 0.05), and no recurrence of knee pain was observed during follow-up. In the control group, there was no significant difference in Lysholm score and SF-36 scale score between pre-and post-treatment (P > 0.05); there were significant differences in WOMAC score between pre-treatment and at 1, 2, 3 months after treatment (P < 0.05); at 3 months after treatment, 11 patients had joint pain symptoms again. No significant difference was found in the knee joint function score and SF-36 scale score at 1 and 2 months after treatment between 2 groups (P > 0.05), but the scores of the cell treatment group were significantly better than those of the control group at 3 and 6 months (P < 0.05). ConclusionIt can significantly improve the joint function and quality of life to use intra-articular injection of human umbilical cord MSCs for treating degenerative knee osteoarthritis. It takes effect after 1 month and the treatment effect can be sustained for 6 months.
ObjectiveTo detect the metabolites of the serum and joint fluid from rabbits’ osteoarthritis model with 1H nuclear magnetic resonance spectroscopy (NMR) technique, study the metabolic differences and connections of serum, synovial and cartilage of rabbits after the articular cavity injection of sodium hyaluronate, and explore osteoarthritis and metabolic mechanism in the process of treating sodium hyaluronate using sodium hyaluronate, thus provide new ideas and basis of the specific mechanisms in the treatment of osteoarthritis via sodium hyaluronate.MethodsWe selected 30 healthy New Zealand white rabbits, 6 months old, and randomly divided them into three groups as follows: blank control group, model phosphate buffer saline (PBS) liquid injection group and model injection of sodium hyaluronate group, with 10 rabbits in each group. Ten weeks after surgery, all experimental animals were put to death and observed in correlation studies regarding general condition, imaging examination, and histological examination. Metabolites 1H NMR detection and data preprocessing were performed in the serum and joint fluid samples.ResultsThe results considering general condition, general sample observation, imaging examination and histology indicated advantages in sodium hyaluronate group over PBS group. Metabolomics analysis showed statistically significant changes of metabolites in the serum and joint fluid compared with the PBS group and the blank control group (P<0.05). According to the relevant ways of differences metabolites retrieval, analysis found that the effect of sodium hyaluronate on osteoarthritis might be related to protein biosynthesis, amino acid circulation, the metabolic process of pyruvic acid, gluconeogenesis and other metabolic pathways.ConclusionsBased on the research of 1H-NMR metabolomics, the results suggest that the effect of sodium hyaluronate on osteoarthritis is mainly related with the activation of protein metabolism, abnormal lipid and energy metabolic pathways. This study provides new ideas and basis on the concrete mechanism in the treatment of knee osteoarthritis using sodium hyaluronate.